Section of Hepatopancreaticobiliary and Transplant Surgery, McGill University Health Centre, Montreal, Canada.
HPB (Oxford). 2011 Feb;13(2):79-90. doi: 10.1111/j.1477-2574.2010.00268.x.
The diagnosis and treatment of indeterminate dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the literature on the subject is scarce.
This review aims to appraise and synthesize the evidence published in the English-language medical literature on this topic.
Scientific papers published from 1950 until week 4 of July 2010 were extracted from MEDLINE, Ovid Medline In-Process, the Cochrane Database of Systematic Reviews, the Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, EMBASE, PubMed and the National Library of Medicine Gateway.
Strategies for the optimal management of DS in PSC patients are supported only by level II and III evidence. Intraductal endoscopic ultrasound appears to be the most sensitive (64%) and specific (95%) diagnostic test for the evaluation of DS in PSC. Endoscopic and percutaneous dilatations achieve 1- and 3-year palliation in 80% and 60% of patients, respectively. Although dilatation and stenting are the most common palliative interventions in DS, no randomized trials on the optimal duration of treatment have been conducted.
In benign DS, endoscopic dilatation with short-term stenting seems to be effective and safe and does not increase the risks for malignant transformation or complications after liver transplantation. Surgical bile duct resection and/or bilioenteric bypass are indicated only in patients with preserved liver function.
原发性硬化性胆管炎（PSC）患者的不定型优势狭窄（DS）的诊断和治疗具有挑战性，且该主题的文献很少。
本综述旨在评估和综合发表在英文医学文献中的该主题证据。
从 MEDLINE、Ovid Medline In-Process、Cochrane 系统评价数据库、系统评价数据库、疗效评价文摘数据库、EMBASE、PubMed 和美国国家医学图书馆网关提取 1950 年至 2010 年 7 月第 4 周发表的科学论文。
仅为 PSC 患者 DS 的最佳管理策略提供了 II 级和 III 级证据。腔内超声内镜检查似乎是评估 PSC 中 DS 的最敏感（64%）和最特异（95%）的诊断性检查。内镜和经皮扩张术分别使 80%和 60%的患者在 1 年和 3 年内获得缓解。尽管扩张和支架置入术是 DS 中最常见的姑息性干预措施，但尚未进行关于最佳治疗持续时间的随机试验。
在良性 DS 中，内镜扩张伴短期支架置入似乎有效且安全，并且不会增加恶性转化或肝移植后并发症的风险。只有在肝功能正常的患者中，才需要进行手术胆管切除和/或胆肠旁路。
